‘SHARE Plan’ Proposed to Expand Wyoming Medicaid

The Wyoming Department of Health (WDH) is describing its newly released recommendations for expanding healthcare coverage to thousands of uninsured residents as a fiscally responsible, Wyoming-centered approach.

The department is calling its recommended plan, “Wyoming’s Strategy for Health, Access, Responsibility and Employment,” or the “SHARE Plan.”

People with incomes below the federal poverty line are not eligible for federal subsidies to purchase private insurance or for coverage through Medicaid if they live in a state that has not expanded the program, due to the way the Affordable Care Act was written and related court decisions. “Unless Medicaid is expanded in Wyoming, individuals in this group are left out completely,” said Tom Forslund, WDH director.

“Thousands of uninsured Wyoming residents do not have healthcare coverage, which limits their access to preventive care, leads to increased use of hospital emergency departments, and results in large amounts of unpaid care,” Forslund said. “This is not good for these individuals and is a burden on Wyoming’s healthcare system.”

If approved by the Wyoming Legislature and signed into law, the SHARE Plan for Wyoming Medicaid expansion would include two new programs based on participant income:

Participants with higher incomes (101-138 percent of federal poverty level) would take part in a demonstration project, paying a small monthly premium to receive an alternative benefits package.

Participants with lower incomes (less than 100 percent of the federal poverty level) would receive the alternative benefits package but would not participate in the demonstration project and would not have to pay a monthly premium.

Both groups would be required to pay small co-payments for certain services and have access to the Wyoming Medicaid provider network.

Both groups would be connected with work assistance benefits available through the Department of Workforce Services.

In addition, eligible “medically frail” adults would be enrolled in traditional Medicaid.

“In addition to benefitting 17,000 plus people who may need health coverage, our approach would have a significant benefit for the state’s economy,” Forslund said.

WDH expects that Medicaid expansion would inject $100-120 million in new federal funds each year into Wyoming’s economy. An analysis conducted jointly between WDH and the Wyoming Department of Administration and Information’s Economic Analysis Division suggests this funding would create approximately 800 new jobs.

“Each year Wyoming does not expand Medicaid, we pass up these millions in federal funds that we could be putting to work in our state,” Forslund said. “In other words, Wyoming taxpayers are currently helping to pay for Medicaid expansion in other states without seeing any benefits closer to home.”

Forslund expects Wyoming will be able to expand coverage without increasing the amount of state general funds spent on healthcare. “We could eliminate or reduce a number of programs within WDH that currently provide needed healthcare services to individuals with no other pay source.”

Because expansion would shift financing from programs that use primarily state general funds to Medicaid, which is funded by both state and federal funds, the expansion effort would be revenue-neutral.

Forslund noted that options popular in other states involving private health insurance coverage were more costly in this state than a program administered through Wyoming Medicaid. “The cost estimates for a premium assistance expansion plan were significantly more expensive than our chosen approach because Wyoming’s premiums available through the federal health insurance marketplace are quite high. Because we want to be fiscally responsible, we decided that was not the right approach for Wyoming,” he said.

The plan includes a provision that if higher than normal federal Medicaid matching funding levels promised by the Affordable Care Act were to drop below 90 percent for individuals covered by expansion, the expansion programs would automatically end.

An amendment to the budget bill passed by the Wyoming Legislature in 2014 authorized the governor, WDH and the Wyoming Department of Insurance to begin conversations with federal officials on a potential Medicaid expansion approach.

“We’ve had a number of conversations with key representatives of the Centers for Medicare and Medicaid Services. These discussions went well and they were receptive to many of our ideas,” Forslund said. “So, we’re now able to propose a plan for the legislature to consider during its upcoming session.”